Safe reliable atraumatic replacement of misplaced paediatric tracheostomy tubes.

OBJECTIVE: Displacement of tracheostomy tubes, especially soon after insertion has a high morbidity and mortality rate. We present a safe atraumatic reliable method of tracheostomy tube replacement.

SETTING: Tertiary paediatric centre.

MATERIALS AND METHODS: The method involves using a suction catheter placed in the trachea. Its position can be confirmed by suctioning tracheal secretions. The catheter can be used to employ the Seldinger technique for replacement of the tracheostomy tube and can be used to jet ventilate the patient if there is failure to site a tube. This buys time while a surgical airway is placed. We also outline the minimum contents of the emergency box, which should be carried at all times by the carers of a child with a tracheostomy.

CONCLUSIONS: Use of a suction catheter is a safe reliable atraumatic way of replacing a tracheostomy tube.